Integrated Health and Social Care Board March, 2012
Legacy Statement: Final
David Francis
Chair
Mr J House
Chief Executive
Cardiff Council
County Hall,
Atlantic Wharf,
Cardiff.
CF10 4UW
30th March 2012
Our ref: DF/as/03/1832
Dear Mr House
RE: LEGACY STATEMENT BY THE OUTGOING CHAIR OF THE INTEGRATED HEALTH AND SOCIAL CARE PROGRAMME BOARD
I write to you all in my capacity as outgoing Chair of the Integrated Health and Social Care Board (IHSCB) and enclose a Legacy Statement which has been prepared as a briefing for all new members joining the IHSCB over the next few months.
The last year has seen the IHSCB progress from a relationship building group to the current situation where it is poised to help deliver real whole systems change within our community. There is an emerging acceptance that historical ways of working, constrained by artificial organisational boundaries, have been unable to bring about the quality of service we would wish for our family, friends and wider community. Instead, there has been a growing awareness of the need to work collectively to combat longstanding service challenges. Indeed, we have already taken our first steps to invest both physical resources and personal reputations in tangible partnerships to enhance our communities.
Detailed action plans have been developed for all four identified workstreams and good progress is being made. However, to ensure success, especially given the short term disruption to IHSC Board membership, then it will require your ongoing personal support over the coming months.
Whilst all four workstreams are important in their own right, the programme of work associated with addressing the needs of the Frail Elderly population and the challenges faced by all our organisations in meeting those requirements, have taken the highest priority. The last year has been spent in identifying and bringing together the various strands of work relating to this pressurised area.
The Wyn Campaign has now entered its second phase with the aim of delivering an agreed implementation plan. The attached document gives further information on the key steps required at senior level to ensure that it is effective.
It has taken a while to develop the real cross organisational understanding and holistic approach to using our collective resources more effectively, but it is the view of all members that the IH&SC Board has now reached a point of maturity that offers much to our respective organisations and, of course, citizens. I would commend to you the Board’s work programme, and would ask that you collectively consider progress to date, and that you ensure the Board’s work programme is properly supported during the next few months transition period.
May I take this opportunity of wishing you and your organisations all the very best in the work that lies ahead.
Yours sincerely
DAVID FRANCIS
Chair
Integrated Health and Social Care Programme Board
Working together to meet the needs of people in Cardiff and the Vale of Glamorgan
Legacy Statement – March, 2012
Executive Summary
The Integrated Health and Social Care Programme Board is the only established forum bringing together senior representatives from all three statutory organisations and 3rd Sector partners providing health and social care for both Cardiff and the Vale of Glamorgan localities. Its work programme targets areas of long-standing, high risk where efficiencies may be achieved through closer collaboration.
4 areas of work have been identified but the Wyn Campaign (for frail older people including those with Cognitive Impairment) is prioritised as fundamental in addressing longstanding Delayed Transfer of Care issues.
Imminent personnel changes within 4 of the 5 partners, combined with temporary programme management support, pose a substantial threat to the work. This Legacy Statement has been prepared by the outgoing Chair for circulation to the Leads of all organizations outlining achievements so far and suggesting next steps to aid continuity.
The following issues are particularly noteworthy:
(i) The Institute of Public Care has initiated work on detailed capacity and demand modelling to inform joint commissioning of long-term care as part of the Wyn Campaign. Welsh Government funding is only provided for the first 6 days of a projected 30 day project. Should the initial 6 day phase prove fruitful, all 3 public organisations will be approached to support the remaining work.
(ii) There is current discussion with Welsh Government regarding a possible Invest to Save bid to support the Wyn Campaign delivery plan and ongoing Programme support. IHSCB colleagues have indicated support in principle. There is also a joint understanding that any resources must be delivered alongside a plan for serious transformational change. Significant progress has been made in reaching this joint conclusion but careful management will now be required to ensure that this agreement in principle is endorsed actively across the healthcare community.
(iii) The incoming Chair of Cardiff and Vale UHB is being invited to take the Chair of the IHSCB for the next 6 months to help manage the transition period. All leads of the Partner organisations are asked to support this proposal.
1. Introduction
The Integrated Health and Social Care Programme Board (IHSCB) is the only established forum that brings together senior representatives from all three statutory organisations and 3rd Sector partners providing health and social care for both Cardiff and the Vale of Glamorgan localities.
The IHSCB has overseen vital work in laying the foundation for all five partners to work together in delivering a challenging agenda of whole system service re-design for key population groups within our community. The partners have agreed and implemented a work programme which is targeted at areas of long-standing, high risk from both a user and managerial perspective and where it is considered that efficiencies may be achieved through closer collaboration. This existing momentum makes the Board ideally placed to demonstrate immediate compliance with Welsh Government requirements for partners to collaborate across the whole public service system in order to achieve tangible service improvement throughout a geographical area. Further it offers a mechanism which is flexible enough to change in response to future changes in requirement.
Given the potential for significant changes in Board membership over the next few months, it seems timely to have available a progress review from the past year. This Legacy Statement concludes with some suggested 'next steps' for consideration by incoming colleagues.
2. Overall Context for Collaborative Service Planning
2.1 Welsh Government Requirements and Specific Locality Responses
In line with Welsh Government (WG) requirements, partner agencies have produced collaborative strategies around health, social care and well-being, children and young people, and community safety. The strategic partnerships in both Cardiff and the Vale of Glamorgan adopted new, more integrated approaches to the development of ten-year plans, submitted to the WG over the summer following 12 week public consultations.
In Cardiff, a collective vision and a set of high level priorities for the city are set around seven shared citizen outcomes. The Cardiff ‘What Matters 2010:2020’ ten year strategy and Delivery Plan can be found at www.cardiffproudcapital.co.uk
In the Vale of Glamorgan, an integrated Community Strategy has been prepared around ten overarching priority outcomes. The Vale of Glamorgan Community Strategy 2011-2021 and Delivery Plan can be found at www.valeofglamorgan.gov.uk/communitystrategy
The UHB is a joint signatory to both strategies, which are in turn aligned to the UHB 5 Year Framework. The supporting Delivery Plans are similarly aligned to the UHB Operational Plan 2011/12.
Colleagues from the Third Sector have been involved closely in the development of these strategies with signatures from a variety of stakeholders on both plans.
2.2 Working Arrangements in our two Local Authority Areas
In both local authority areas, the development of integrated strategies has led to the establishment of new joint partnership models to provide a more effective and streamlined means of addressing the major challenges. Both are founded in an emphasis on delivering outcomes; they include a business intelligence function, locality working, effective performance management and personal accountability. Partners typically include local authorities (social services, education, housing, economic regeneration), third sector, police, fire and rescue and the independent sector.
In the Vale of Glamorgan, the Local Service Board will continue to oversee arrangements and overall delivery of the Community Strategy, and partnership boards will be retained for children and young people and community safety. However, the existing structure has been revised to include:
· Three multi-agency Area Working Groups to address joint areas of concern at a local level;
· A Public Health and Wellbeing Board with authority-wide representation to prevent avoidable ill health or injury, lifestyle diseases and their determinants;
· Reduced and re-aligned partnership groups to support the planning and delivery of the Community Strategy.
In Cardiff, an Integrated Partnership Board (IPB) has replaced the existing Partnership Boards for health, social care and well-being, children and young people, and community safety. The IPB is a re-focussed Local Service Board comprising chief executives of key partner agencies and will oversee the delivery of the What Matters Strategy. The delivery structure sitting beneath the IPB is made of 3 key elements:
· Task and Finish groups progressing priorities that need to be addressed on a city wide basis or because of the statutory nature of the agenda
· Neighbourhood groups whose focus is on developing local solutions to local issues identified through quantitative and qualitative needs assessment. These 6 groups have a clear link to the UHB Locality Teams based in the Primary, Community and Intermediate Care Division.
· Issues which cross more than one local authority area.
Appendix 1 offers a diagram of the overall partnership framework which is overseen by the three separate Partnership Boards and outlines the key priorities for each.
2.3 Future Developments
The Welsh Government has run a series of engagement events testing out its thinking on plan and partnership rationalisation. A Policy Outline document sets out WG proposals for single integrated plans, a reduction in the number of partnerships and strengthened accountability and scrutiny. Implementation of the Simpson Review is highlighted as providing an opportunity to simplify the landscape including the potential merger of adjacent LSBs in line with the regional public service collaboration footprint set out in the Programme for Government 2012-2016. Draft guidance: ‘Shared Purpose, Shared Vision’ on these new proposals has been issued for consultation with final guidance being anticipated in the Summer of 2012.
The Local Government Measure 2011 will also have a significant impact on how partners are held to account on performance. The most important provision in the Measure is the requirement for Local Government Scrutiny Committees to scrutinise public service providers in the area. A Ministerial Order is in the process of being developed for consultation, which will identify which public service providers will be subject to Local Government scrutiny. Those providers covered by the order will have to provide information to scrutiny committees if requested, be required to attend meetings to provide information and answer questions, as well as having to respond to any reports or recommendations made by scrutiny.
2.4 Where does the IHSCB fit with this agenda?
The strategies for both Cardiff and the Vale of Glamorgan have identified various health and social care issues which require addressing across the Cardiff and Vale communities. As a result, both unitary authority areas have given the Integrated Health and Social Care Programme Board responsibility for improving the quality, integration and sustainability of ‘overlapping’ health and social care services. It is imperative that the Board delivers tangible improvements for local people as prioritised by the respective local authority strategies.
4 key areas of work have been identified in the first instance as requiring programmes for greater service integration, specifically:
· Frail Older People, including those with Cognitive Impairment;
· Learning Disabilities;
· Mental Health;
· Children with Complex Needs.
It is likely that a 5th workstream will be added in the near future relating to Carers.
3. What has the IHSCB achieved so far?
· Senior Level Political and Managerial Sponsorship – The IHSCB is recognised and supported by the Executive Teams of all three sovereign bodies. There is tangible ownership of its priorities by all five partners, along with a perceptible wish to move beyond partnership rhetoric to achieve true on-the-ground collaboration;
· Collaborative Agreement (See Appendix 2) – all parties have signed up to this document which details the governance arrangements and responsibilities of both individuals and their organisations to ensure accountability for decisions and progress.
· Clearly identified workstream priorities with a special focus upon the Frail Elderly population in the first year.
· Structured approach to partnership working – the Board has developed a sound framework to manage the partnership agenda using a Programme Management approach encompassing performance management (using Results Based Accountability methodology), reporting and scrutiny mechanisms, communications and Organisational Development.
· Whole system, detailed action plans for all four priority areas, with tangible progress in addressing long standing ‘wicked issue’ service concerns.
· Commitment of resources by the three statutory organisations, with dedicated time from support officers and considerable commitment from the Senior Responsible Officers (SROs) from each of the priority areas.
· Jointly funded appointments to support key workstreams in Mental Health, Learning Disabilities, Vale Locality management and the Programme as a whole.
3.1 The Wyn Campaign
The Delivery Plan for Year 1 has successfully:
- Produced an agreed vision and model for future service delivery;
- Mapped and undertaken a gap analysis for the development of the Community Locality ‘Toolbox”, co-ordinating wrap-around services to support frail older people in the community to retain independence;
- developed a plan to improve the experiences of frail older people in hospital, including advice and liaison in the Emergency Unit and an integrated Discharge Support Service;
- Developed outline proposals for Phase 2 of the Community Resource teams;